Acute Delays in Pediatric Primary Care Delivery Due to the Pandemic

Alkureishi, Lolita Alcocer

doi:10.3928/19382359-20220902-01

Cited by 1 publication

(3 citation statements)

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“…8 Studies have also described delayed diagnosis and treatment of a variety of conditions, thereby increasing the risk of morbidity, mortality, disability, preventable intensive care admissions, and extensive health care expenditures. [9][10][11][12][13][14][15][16][17] Studies examining the prevalence of delayed or missed pediatric preventive care during the COVID-19 pandemic in a nationwide sample of US children are scarce, and only a few have explored potential determinants. 4,5 Such studies did not examine potential risk factors such as child age, main caregiver physical or mental health, home ownership, having a usual source of pediatric preventive care, having a personal doctor or nurse, perceived child health, and evaluated child health, 4,5 which may have resulted in residual confounding, because such factors may affect health care access and use.…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, studies have highlighted reductions in routine childhood immunizations during times of quarantine, increasing the potential for a resurgence in preventable diseases and associated mortality . Studies have also described delayed diagnosis and treatment of a variety of conditions, thereby increasing the risk of morbidity, mortality, disability, preventable intensive care admissions, and extensive health care expenditures …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Racial and Ethnic Differences in Factors Associated With Delayed or Missed Pediatric Preventive Care in the US Due to the COVID-19 Pandemic

2023

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ImportanceThe COVID-19 pandemic has disrupted medical care use. Yet information on how the pandemic has affected pediatric preventive care use in the US is lacking.ObjectiveTo examine the prevalence of and risk and protective factors for delayed or missed pediatric preventive care in the US due to the COVID-19 pandemic, further stratified by race and ethnicity to assess associations by groups.Design, Setting, and ParticipantsThis cross-sectional study used data from the 2021 National Survey of Children’s Health (NSCH) collected between June 25, 2021, and January 14, 2022. Weighted data from the NSCH survey are representative of the population of noninstitutionalized children aged 0 to 17 years in the US. For this study, race and ethnicity were reported as American Indian or Alaska Native, Asian or Pacific Islander, Hispanic, non-Hispanic Black, non-Hispanic White, or multiracial (≥2 races). Data analysis was performed on February 21, 2023.ExposuresThe Andersen behavioral model of health services use was used to assess predisposing factors, enabling factors, and need factors.Main Outcomes and MeasuresThe main outcome was delayed or missed pediatric preventive care due to the COVID-19 pandemic. Bivariate and multivariable Poisson regression analyses were performed using multiple imputation with chained equations.ResultsOf the 50 892 NSCH respondents, 48.9% were female and 51.1% were male; their mean (SD) age was 8.5 (5.3) years. With regard to race and ethnicity, 0.4% were American Indian or Alaska Native, 4.7% were Asian or Pacific Islander, 13.3% were Black, 25.8% were Hispanic, 50.1% were White, and 5.8% were multiracial. More than one-fourth of children (27.6%) delayed or missed preventive care. In multivariable Poisson regression using multiple imputation, Asian or Pacific Islander children (prevalence ratio [PR], 1.16 [95% CI, 1.02-1.32]), Hispanic children (PR, 1.19 [95% CI, 1.09-1.31]), and multiracial children (PR, 1.23 [95% CI, 1.11-1.37]) were more likely to have delayed or missed preventive care compared with non-Hispanic White children. Among non-Hispanic Black children, risk and protective factors included age 6 to 8 years (vs 0-2 years [PR, 1.90 (95% CI, 1.23-2.92)]) and difficulty covering basic needs somewhat or very often (vs never or rarely [PR, 1.68 (95% CI, 1.35-2.09)]). Among multiracial children, risk and protective factors included age 9 to 11 years (vs 0-2 years [PR, 1.73 (95% CI, 1.16-2.57)]), lower household income (&lt;100% vs ≥400% federal poverty level: 0.52 [0.35-0.79]), and 2 or more vs 0 health conditions (PR, 1.54 [95% CI, 1.14-2.08]). Among non-Hispanic White children, risk and protective factors included older age (9-11 years vs 0-2 years [PR, 2.05 (95% CI, 1.78-2.37)]), 4 or more children vs 1 child in the household (PR, 1.22 [95% CI, 1.07-1.39]), fair or poor vs excellent or very good caregiver health (PR, 1.32 [95% CI, 1.18-1.47]), difficulty covering basic needs somewhat or very often (vs never or rarely [PR, 1.36 (95% CI, 1.22-1.52)]), good vs excellent or very good perceived child health (PR, 1.19 [95% CI, 1.06-1.34]), and 2 or more vs 0 health conditions (PR, 1.25 [95% CI, 1.12-1.38]).Conclusions and RelevanceIn this study, the prevalence of and risk factors for delayed or missed pediatric preventive care varied by race and ethnicity. These findings may guide targeted interventions to enhance timely pediatric preventive care among different racial and ethnic groups.

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